Anticoagulation is Associated with Decreased Inferior Vena Cava Filter-Related Complications in Metastatic Carcinoma Patients.
Am J Med. 2016 Jul 28;
Authors: Mahmood SS, Abtahian F, Fogerty AE, Cefalo P, MacKay C, Jaff MR, Weinberg I
BACKGROUND: Patients with metastatic carcinoma and venous thromboembolism commonly have contraindications to anticoagulation that prompts use of retrievable inferior vena cava filters.
OBJECTIVES: The aim of this study was to compare the pattern of inferior vena cava filter use, anticoagulation management and development of inferior vena cava filter related complications in patients with localized versus metastatic carcinoma.
METHODS: We conducted a retrospective cohort study of inferior vena cava filter use at a tertiary referral hospital between January 1, 2009 and December 31, 2011. Including only cancer patients with carcinomas, both metastatic and localized, we recorded indications for inferior vena cava filter, post-filter practices including anticoagulation use, filter retrieval rates, and filter related complications.
RESULTS: Overall, 154 patients with carcinoma underwent inferior vena cava filter placement. Basic demographics and indication for filter placement were similar between metastatic and localized groups. Metastatic patients had more filter related complications (25% vs. 11%, p=0.03) and underwent filter retrieval less often (31% vs. 58%, p=0.01). Time to re-initiating anticoagulation was longer in metastatic patients (5.5 days vs. 2 days, p=0.05). In multivariate analysis, metastatic disease was associated with reduced inferior vena cava filter retrieval (OR 0.3, p=0.003). Anticoagulation use was associated with a lower rate of filter-related complications (OR 0.3, p=0.005).
CONCLUSIONS: Metastatic carcinoma patients with indwelling inferior vena cava filter had a higher rate of filter related complications, a lower filter retrieval rate and greater median time to initiating anticoagulation. When possible, early re-initiation of anticoagulation may reduce inferior vena cava filter related complications.
PMID: 27477669 [PubMed - as supplied by publisher]